Absent right superior vena cava (SVC) with persistent left SVC in visceroatrial situs solitus is a rare congenital anomaly occurring in 0.07-01.3% of congenital heart malforma-tion[1]. It is commonly associated with other congenital heart defects in 46% [2]. Here, we report a case of ostium secundum atrial septal defect (ASD) associated with this anomaly in a
patient who underwent Amplatzer Septal Occluder (ASO) implantation.
Case Description
An 11-year-old boy presented with presented with frequent tiredness during exertion. Physi-cal examination revealed widely fixed splitting S2 with normal P2 and grade 2/6 systolic ejec-tion murmur along the left upper sternal border (pulmonary valve area). His EKG had an ab-normal P axis (-15O), right axis deviation for age (+120O), and pure R in V1 (Figure 1).
Absent Right and Persistent Left
Superior Vena Cava: Case Report
C O N G E N I T A L C A R D I O L O G Y T O D A YTimely News and Information for BC/BE Congenital/Structural Cardiologists and Surgeons
IN THIS ISSUE
Absent Right and Persistent Left Superior Vena Cava: Case Reportby Anant Khositseth, MD~Page 1
Charles E. Mullins Interventional Lecture Seriesby Frank Ing, MD ~Page 5
Highlights of PICS - AICS 2008by Ziyad M. Hijazi, MD ~Page 6
DEPARTMENTS
Medical News, Products and Information ~ Page 8
December Congress Focus - ICCA Frankfurt 2008 (International Course on Carotid Angioplasty)~ Page 10
Upcoming Medical Meetings & Symposia~ Page 11
CONGENITAL CARDIOLOGY TODAY
Editorial and Subscription Offices16 Cove Rd, Ste. 200Westerly, RI 02891 USA
Statements or opinions expressed in Congenital Cardiology Today reflect the views of the authors and spon-sors, and are not necessarily the views of Congenital Cardiology Today.
Volume 6 / Issue 10
October 2008
International Edition
By Anant Khositseth, MD
Figure 1. A 12-lead electrocardiography demonstrated ectopic atrial pacemaker (upright P wave in I and negative P wave in aVF, bold arrow) and pure R in V1 (dash arrow) indicated right ventricle hypertrophy.
RECRUITMENT ADVERTISING FOR Europe, Asia, Middle East, Australia
A chest x-ray demonstrated mild cardiomegaly with slightly in-creased pulmonary vasculature. All of these findings were sugges-tive of an ASD. Echocardiography demonstrated mild dilatation of the right atrium and ventricle, ostium secundum ASD (8 mm in di-ameter), and dilated coronary sinus suspected left SVC. He was scheduled for cardiac catheterization for device closure by ASO. Tranesophageal echocardiography (TEE) was performed during the catheterization. This demonstrated an ostium secundum ASD with stretched diameter of 14 mm., a dilated coronary sinus, and adequate rims for device closure. A 24-mm balloon sizing was in-flated with stretched diameter of 14 mm. by fluoroscopy (Figure 2). A catheter could not be passed from the right atrium into the right SVC, but it could be passed from the right atrium through dilated
coronary sinus, left SVC, right innominate vein, and right internal jugular vein. The contrast was injected into the right internal jugular vein and the left SVC, respectively. This injection demonstrated ab-
sent right SVC and persistent left SVC draining into the coronary sinus and the right atrium (Figure 3). The pulmonary to systemic blood flow was calculated and equal to 2.8 indicated large left to right shunt. The pulmonary arterial pressure was normal with mean of 20 mm Hg. A 14-mm ASO was selected to close the ASD successfully.
Figure 2. A fluoroscopy demonstrated a waist in balloon sizing (bold arrows) indicated a stretched diameter of the atrial septal defect.
October 2008 2 CONGENITAL CARDIOLOGY TODAY
WATCH LIVE CASES
ON THE WEBPerformed by Experts in the field
Hosted by Congenital Cardiology Today
www.CHDVideo.com
From ISHAC 2008 LIVE CASES• NCH Hybrid Catheterization/OR Suites
• Pulmonary Artery Flow Restrictors
• Transcatheter Valve
• Intra-operative PA Stent
• Perventricular Muscular VSD Device Closure
• Perventricular Muscular VSD Device Closure
• Perventricular Muscular VSD Device Closure
• Closure of Septal Defect Using Real Time 3D Echo Guidance
From ISHAC 2007 LIVE CASES
• Perventricular Muscular VSD• Perventricular Membranous VSD• Hybrid Stage I Palliation for HLHS PA Bands and PSA Stent• Intraoperative Aortic Stent for CoA• Intraoperative LPA Stent Using Endoscopic Guidance• Creation of ASD after PA Bands & PDA Stent for HLHS in a
Preemie• Perventricular Implant of Edwards Valve Stent in the Pulmonary
Position• Closure of Septal Defect Using Real Time 3D Echo guidance• High Frequency Ultrasound Creation of ASD
From PICS-AICS 2007 LIVE CASES
• PmVSD Closure• Percutaneous Closure of ASD(s) with TEE or ICE Guidance• Percutaneous Valve Implantation• Hybrid Stage I Palliation for Complex Single Ventricle in a 1.4 kg
Neonate• Transcatheter Implantation of Implantable Melody Valve
From 6th INTERNATIONAL WORKSHOP IPC LIVE CASE
• Perimembranous VSD Closure with Amplatzer Membranous SD
The echocardiography performed at 1 day and 3 months after the procedure demonstrated proper position of the device without residual shunt. The ASO device did not obstruct the dilated coronary sinus.
Discussion
Bilateral SVC with persistent left SVC draining into the coronary sinus and then the right atrium which is a normal variation of normal systemic venous return is not uncommon in general, occurring in 0.3% of the general population. This condition is commonly associated with congenital heart defects in 3-34% of patients. However, persistent left SVC with absence of the right SVC is very rare. Bartram et al.[2] reported 121 cases with the absence of the right SVC in visceroatrial situs solitus found that this anomaly is typically characterized by persistent left SVC draining into the right atrium via the coronary sinus and addi-tional cardiac defects could be found in 46% of these cases. Srivastava et al.[3] reported a case with persistent left SVC with absent right SVC associated with ostium secundum ASD which was accidentally detected during the surgical closure of the ASD due to the right internal jugular triple lumen venous catheter placement.
In this case report we successfully closed the ostium secundum ASD by using an ASO device. TEE performed before the proce-dure demonstrated dilated coronary sinus which was suspected to have the persistent left SVC, but the absent right SVC was not detected. However, the venous catheter course and angi-ography demonstrated absent right SVC and persistent left SVC
A B
Figure 3. Angiography in the right internal jugular vein (IJV) (3 A) and the left superior vena cava (SVC) (3 B) demonstrated absent right superior vena cava (SVC), right internal jugular vein (IJV) draining via the right innominate vein, and the persistent left SVC draining into the right atrium via the dilated coronary sinus (CS).
Figure 4. Fluoroscopy of a 14-mm Amplatzer septal occluder after deployment.
draining into the right atrium via dilated coronary sinus. We thought that this finding was of concern due to the possibility of the device obstructing the dilated coronary sinus and its orifice. During the device deployment, we selected the size of the device properly using the stretched diameter of the defect by measuring the sizing balloon by TEE and fluoroscopy. We were also aware of the device position related to the large orifice of the coronary sinus by imaging of the TEE. Figure 4 demonstrated the ASO device in the proper position after the deployment. The patient’s EKG had abnormal P axis, which indicated ectopic atrial pace-maker. This finding was reported in 3 of 4 hearts with absent right SVC, and may be the key factor in the development of arrhyth-mias [4]. The incidence of arrhythmia after device closure may be increased in this patient.
To our knowledge, this was the first case report of Absent Right and Persistent Left Superior Vena Cava in which an as-sociated ASD was closed by the ASO device. Although this is a rare condition, we do recommend all patients with ASD under-going device closure should be performed complete echocar-diography to examine the systemic venous drainage to the heart thoroughly.
References
1. Bartram U, Van Praagh S, Levine JC, et al. (1997) Absent right superior vena cava in visceroatrial situs solitus. Am J Cardiol 80:175-183.
2. Lenox CC, Zuberbuhler JR, Park SC, et al. (1980) Absent right superior vena cava with persistent left superior vena cava: implications and management. Am J Cardiol 45:117-122.
3. Lenox CC, Hashida Y, Anderson RH, et al. (1985) Conduc-tion tissue anomalies in absence of the right superior caval vein. Int J Cardiol 8:251-260.
4. Srivastava V, Mishra P, Kumar S, et al. (2007) Persistent left SVC with absent right SVC: a rare anomaly. J Card Surg 22:535-536.
On May 30, 2008, Texas Children’s Hospital held its 2nd An-nual, “Charles E. Mullins Interventional Lecture Series,” in honor of the lifetime contribution of Dr. Mullins.
Dr. Mullins retired at the end of 2006 and this series started with a lecture by Dr. Philip Bonhoeffer, entitled, “The Pulmo-
nary Valve Stent" in January, 2007. The second lecture of this series was provided by Dr. Zahid Amin, entitled “Perventricular Occlusion of Muscular VSD’s.”
The event started with an informal dinner held the evening before, attended by current staff and some of Dr. Mullins’ former trainees working in other pediatric cardiac centers. Following the lecture, which was attended by approximately 50 people, a “Charles E. Mullins” display case was unveiled at the Texas Children’s Hospital heart center library and learning center. The display case was in-tended to show off some of Chuck’s collection of publications, cathe-ters, antiques and other historically important artifacts pertaining to pediatric cardiology interventions.
Overall, it was a great time for a mixture of academic discussions and renewal of old friendships. If the reader has any “old artifacts” of Chuck’s, and would like to donate them to the “Mullins” display case, please contact the author.
The date for the third lecture will be sometime in the Spring of 2009. Those interested in possibly attending, are encouraged to send an email to the author, and information will be sent when available.
Charles E. Mullins in front of the plaque that bears his name.
Left to right: Frank Ing, Tom Fagan, Jeff Towbin, Zahid Amin, Charles Mullins, Richardo Pignatelli, Howaida El-Siad and Chris Petit.
“Texas Children’s Hospital held its 2nd Annual, “Charles E. Mullins Interventional Lecture Series,” in honor of the lifetime contribution of Dr. Mullins.”
CONGENITAL CARDIOLOGY TODAY 5 October 2008
Update on Pediatric and Congenital Cardiovascular DiseaseStrategies to Improve Care Through a Multidisciplinary Approach
With over 700 attendees from 65 countries, PICS (Pediatric and Adult Interventional Therapies for Congenital and Valvular Heart Disease) was a huge success. Fifty percent of the attendees were from the US. A faculty of ninety-five members participated, the largest of its kind in the world.
Similar to last year, we combined the pe-diatric and adult sessions for interven-tional therapy of congenital and structural heart disease. Live cases from twelve sites were transmitted via satellites to the venue at the Bellagio Hotel. The quality of live cases this year was outstanding.
PICS started Sunday July 20th at 8:30 AM with an industry-sponsored workshop (Cook Medical). The workshop was well-attended due to its excellent faculty and subject matter. Among the speakers in this workshop was Dr. Robert White from Yale, who is the world’s expert on pulmonary AVMs. Other speakers included: Drs. Lee Benson, Shakeel Qureshi, Jeff Feinstein, Jo De Giovanni and Omar Galal. Feed-back from attendees on this workshop was overwhelmingly excellent.
In the afternoon, we had an excellent workshop on the atrial septum and imag-ing. There were fourteen talks discussing various aspects of imaging and devices for the septum. In that workshop, there were two excellent debates: one on ICE vs TEE and another on surgery for ASD vs device closure. The last debate between Dr. Fu and Dr. Ilbawi was particularly lively,
The day ended with “Meet the Expert” sessions and oral abstract presentations. At the end of the day, all attendees were invited to the welcome reception in the exhibit hall. This year, we had 29 exhibi-tors representing the wide range of manu-facturers in our field.
The following day, Monday, July 21st, 2008, was full of action. Live cases were transmitted from Danta Pazzanesse Insti-tuto de Cardiologia in Sao Paulo, Brazil, where Dr. Carlos Pedra and his team per-formed four excellent cases; from Rush University Medical Center in Chicago, where Dr. Hijazi and his team performed two cases; from Miami Children’s Hospital, where Dr. Evan Zahn and his team per-formed two cases, and from Seattle Chil-dren’s Hospital where Dr. Tom Jones per-
formed three cases. Between the live cases, there were seventeen excellent talks discussing various aspects of inter-ventional therapies in children and adults. Topics included were the following: Cov-ered Stents, Medical Simulation, Percuta-neous Aortic Valve Therapies, the Mitral Valve (Imaging and Therapies), and Per-cutaneous Pulmonary Valve Implantation. At the end of the day, there were two ex-cellent sessions: one, a debate between Drs. Schranz and Bacha about manage-ment of AS in infants <3 months of age, and the other session was about catheter-izing critically ill babies. Monday included the ever-popular “My Nightmare Case in the Cath Lab” session!
At the end of the day, we had our tradi-tional “PICS Achievement Award.” This year’s recipient was Dr. Carlos Ruiz. Dr. Bill Hellenbrand reviewed Dr. Ruiz’s many accomplishments. Everyone was very impressed with Carlos’ background, and what he has achieved in our field.
Tuesday July 22nd, 2008 was the third full day of the meeting. Again, we had many excellent live cases transmitted from At-lanta, where Dr. Bob Vincent and his team performed two excellent cases; from Co-lumbus Nationwide Children’s Hospital, where Drs. John Cheatham and Mark Galantowicz performed two excellent cases; from Detroit, where Dr. Tom Forbes and his team performed three very good cases, and from San Diego, where Dr. John Moore and his team performed three very good cases. Also on Tuesday, we had twenty-five talks covering a broad range of topics. The topics included the following: a
debate about whether to angioplasty na-tive coarctation, ventricular septal defects, the PFO, the LAA, heart failure monitoring devices, and the PDA.
At the end of the day, the attendees were treated to a night of fun at the traditional Gala Dinner. The gala was very well-attended, and similar to each year, we had drawings from B. Braun and the PICS Foundation for free registration and hotel for two for next year’s PICS.
The last day of the meeting, Wednesday, July 23rd, 2008 was as enjoyable as the first. Again, four sites transmitted live cases. From Cincinnati, Dr. Russel Hirsch and his team transmitted three very good cases. Dr. David Nykanen and his team transmitted two very good cases from Orlando. From St. Louis, Dr. David Balzer transmitted two very educational cases, and from Vancouver, Dr. John Webb and his team transmitted two excellent cases. For the first time at PICS, we had a trans-apical aortic valve replacement transmitted live from Vancouver. The same day we had twelve excellent talks covering: cath lab issues for nurses and techs (inventory
management, sedation in the cath lab, vessel closure devices and surgical procedures in the cath lab); pericardiocentesis; vascular thrombosis and its management; vascular closure devices; hybrid management of HLHS. At the end of the day, five speakers talked about what is coming down the pipe that we should be looking for.
That was our last meeting in Las Vegas, at least for the next two years.
I hope that you all can join us in Cairns, Australia, June 21-23rd, 2009 for PICS at the World Congress of Pediatric Cardiology and Cardiac Surgery. It promises to be educational as usual, but more fun for you and for your family. For more information, go to www.picsymposium.com.
See you in Cairns,
Ziyad M. Hijazi, MD on behalf of all course directors
CCT
Professor Ziyad M. Hijazi, MD, MPH, FSCAI, FACC, FAAP Director, Rush Center for Congenital & Structural Heart DiseaseSection Chief, Pediatric CardiologyProfessor of Pediatrics & Internal MedicineRush University Medical CenterSuite 770 Jones1653 W. Congress ParkwayChicago, IL 60612 USAPhone: (312) 942-6800Fax: (312) 942-8979
z h i j a z i @ r u s h . e d u
CONGENITAL CARDIOLOGY TODAY 7 October 2008
Do you or your colleagues have interesting research results, observations, human interest stories, reports of meetings, etc. that you would like to share with the
congenital cardiology community?
If so, submit a brief summary of your proposed article to Congenital Cardiology Today at: [email protected]
Should We Use Echocardiography to Screen Young Athletes? Sudden and unexpected deaths in young competitive athletes are uncommon, but highly visible events, which raise concern and ethical issues in both the lay public and medical commu-nity. Which is the best strategy to timely identify individuals with cardiac disease responsible for sudden death (primarily, HCM) is largely debated. Namely, the extent to which sophisti-cated testing, such as echocardiography, is needed is still un-defined. To address this question, we carried out an echocardiographic assessment of the structural cardiac diseases in a population of 4,450 athletes, initially judged free of cardiac disease and eligible for competition on the basis of pre-participation screen-ing with 12-lead ECG. None of the 4,450 athletes showed evidence of HCM. Other cardiac abnormalities were detected in only 12 athletes, includ-ing myocarditis (n=4), mitral valve prolapse (n=3), Marfan's Syndrome (n=2), aortic regurgitation with bicuspid valve (n=2), and arrhythmogenic right ventricular cardiomyopathy (n=1). In addition, four athletes were identified with borderline LV wall thickness (i.e., 13 mm) in the "gray-zone" between HCM and athlete's heart. In two of these athletes, subsequent genetic analysis or clinical changes over an average 8-year follow-up resulted, respectively, in a diagnosis of HCM. In conclusion, the pre-participation screening program includ-ing 12-lead ECG appears to be efficient in identifying young athletes with HCM, leading to their timely disqualification from competitive sports. The data also suggest that routine echo-cardiography is not an obligatory component of large popula-tion screening programs designed to identify young athletes with HCM. For more information, European Society of Cardiol-ogy - www.escardio.org
Cardiac Ultrasound Imaging Goes to Handheld Cardiac ultrasound imaging, also known as echocardiography, has been recently challenged by several new imaging meth-ods. However, echocardiography has unique characteristics that make it very attractive: it is cheap, can be done bedside and without ionizing radiation. Recently, devices have also become very small. Actually, in echocardiography there are two diverse and ongo-ing trends: the development of handheld miniature echo de-
vices and even more advanced systems for more quantitative analyses.
Handheld echocardiography makes the method resemble the role of the stethoscope in doctors' everyday work. We may soon see physicians on regular wards or during typical outpa-tient visits taking out pocket size echocardiography machines and checking whether the valves are okay, or if the heart has normal pumping power. Also, identifying life-threatening car-diac issues in emergency environments could be done imme-diately. This exciting development obviously implies an in-crease in the need for training doctors. The current limitation of echocardiography is that the image analysis is subjective and depends on the imager maybe more than with other imaging techniques. This leads us to the sec-ond trend: more automatic analysis of echo images. The novel image tracking systems allow automatic detection of structures such as cardiac walls and cardiac structures and can be visual-ized in 4D. These systems will likely increase the accuracy of the image analysis. It is of great interest to see how these trends will change costs and cost-effectiveness. There are a number of trials studying cost-related issues of the current techniques. Obviously, ad-vanced imaging is more expensive, but so are new therapies. One of the scenarios is, indeed, that advanced imaging is needed to target therapies more accurately, and thereby, make significant savings by more tailored therapy roadmaps.
Mayo Clinic investigators have demonstrated that stem cells can be used to regenerate heart tissue to treat dilated cardio-myopathy, a congenital defect. Publication of the discovery was expedited by the editors of Stem Cells and appeared on-line in the “express” section of the journal’s web site at http://stemcells.alphamedpress.org/.
The study expands on the use of embryonic stem cells to re-generate tissue and repair damage after heart attacks and demonstrates that stem cells also can repair the inherited causes of heart failure.
“We’ve shown in this transgenic animal model that embryonic stem cells may offer an option in repairing genetic heart prob-lems,” says Satsuki Yamada, MD, PhD, cardiovascular re-searcher and first author of the study. “Close evaluation of ge-
netic variations among individuals to identify optimal disease targets and cus-tomize stem cells for therapy opens a new era of personalized regenerative medicine,” adds Andre Terzic, MD, PhD, Mayo Clinic Cardiologist and senior author and principal investigator.
How They Did It
The team reproduced prominent fea-tures of human malignant heart failure in a series of genetically altered mice. Specifically, the “knockout” of a critical heart-protective protein known as the KATP channel compromised heart con-tractions and caused ventricular dilation or heart enlargement. The condition, in-cluding poor survival, is typical of patients with heritable dilated cardiomyopathy.
Researchers transplanted 200,000 em-bryonic stem cells into the wall of the left ventricle of the knockout mice. After one month the treatment improved heart per-formance, synchronized electrical im-pulses and stopped heart deterioration, ultimately saving the animal’s life. Stem cells had grafted into the heart and formed new cardiac tissue. Additionally, the stem cell transplantation restarted cell cycle activity and halved the fibrosis that had been developing after the initial damage. Stem cell therapy also in-creased stamina and removed fluid buildup in the body, so characteristic in heart failure.
The researchers say their findings show that stem cells can achieve functional repair in non-ischemic (cases other than blood-flow blockages) genetic cardiomy-opathy. Further testing is underway.
Others members of the multidisciplinary team are: Timothy Nelson, MD, PhD; Ruben Crespo-Diaz; Carmen Perez-Terzic, MD, PhD; Xiao-Ke Liu, MD, PhD; and Atta Behfar, MD, PhD, of Mayo Clinic; Takashi Miki, MD, Chiba Univer-sity, Japan; and Susumu Seino, MD, Kobe University, Japan.
The research was supported by the Na-tional Institutes of Health, the American
Heart Association, the Marriott Founda-tion, the Ted Nash Long Life Foundation, the Ralph Wilson Medical Research Foundation, and the Japanese Ministry of Education, Science, Sports, Culture and Technology.
Emotional Intelligence Training Might Help Doctors Relate to Patients
Training in emotional intelligence could help medical residents and fellows be-come more sensitive toward their pa-tients, according to a commentary in the September 10, 2008 issue of the Journal of the American Medical Association.
Patients are less likely to complain and more likely to have positive health results if their physician communicates well with them. For these and other reasons, medical schools include interpersonal and communication skills in their training programs. The JAMA article argues that medical education needs to delve even deeper to help doctors relate better.
The four components of emotional intelli-gence — the abilities to (1) perceive, (2) use, (3) understand and (4) manage emo-tions — are building blocks for interper-sonal and communication skills. The chal-lenge in medical education is to under-stand the psychology behind these skills, and build programs to develop them, ac-cording to commentary authors Daisy Grewal, PhD, and Heather Davidson, PhD, of the Department of Medical Educa-tion at Stanford University Medical Center.
The goal is to learn “how we can im-prove assessment tools to better under-stand how to train better doctors,” Davidson said.
Currently, many graduate medical edu-cation programs use self-assessments, which tend to rely on students’ percep-tions of their own personalities. The beauty of ability measurement for emo-tional intelligence evaluation, according to the authors, is that it could separate out personality traits from these core
abilities, giving trainees a more objective assessment of their skills.
The JAMA authors suggest that future studies could link emotional intelligence measurements with performance evalua-tions. Graduate students who score low in one or a combination of abilities, might benefit from targeted training in their weaker abilities.
Grewal and Davidson note that not all educators agree on the value of emo-tional intelligence. Few studies have tested the benefits of training programs, and none has done so within medical education. Some research shows that emotion skills training in medical schools has improved empathy and “soft” skills, suggesting that the right kind of training might help those students who are not natural-born communicators to learn and develop their abilities — assuming they can accurately read and manage their own emotions and those of others.
“Hopefully, such training will improve the caring environment in medicine,” David-son said.
Internet-Based Learning for Health Professions Associated with Positive Effect
A study led by a team of education re-searchers from Mayo Clinic and pub-lished in the Journal of the American Medical Association (JAMA) concludes that Internet-based education generally is effective.
Lead author David Cook, MD, an Asso-ciate Professor of Medicine who prac-tices general internal medicine at Mayo Clinic, worked with researchers from Mayo and McMaster University in Hamil-ton, Ontario. They reviewed more than 200 studies about Internet-based in-struction. The researchers concluded that Internet-based instruction is associ-ated with largely positive effects com-pared with no intervention. The research also showed that Internet-based instruc-
"Our findings suggest that Internet-based instruction is an effective way to teach health care professionals," says Dr. Cook. "We now can confirm that, across a wide variety of learners, learn-ing contexts, clinical topics, and learning outcomes, Internet-based instruction appears to be as effective as similar to traditional methods."
Dr. Cook also notes that Internet-based instruction has unique advantages, in-cluding flexible scheduling, adaptability of instruction, and readily available con-tent that is easily updated. "As health care workers balance challenging prac-tice demands, the ever-expanding vol-ume of medical knowledge requires us to find more effective, efficient ways to learn," says Dr. Cook. "Internet-based instruction will be an important part of the solution."
He also notes that this research likely applies to training outside of health care, citing studies in the engineering, com-puter science, and teaching fields that have shown similar results.
"There is more research to be done as we try to find out how to make Internet-based instruction most appropriate," says Dr. Cook. "We are currently con-ducting research looking at this issue. We also are reviewing other studies to see how to optimize Internet-based in-struction."
Other researchers were Denise Dupras, MD, PhD, Patricia Erwin, and Victor Montori, MD, all of Mayo Clinic; and An-thony Levinson, MD, and Sarah Garside, MD, PhD, from McMaster University.
Last Minute Appeal From the International Children's Heart Foundation (ICHF)
SANTIAGO-DOMINICAN REPUBLICThe ICHF is in need of more PICU nurses for their trip to Santiago, Do-
minican Republic (DR) from Oct. 26-Nov. 8, 2008. The hospital is the Hospi-tal De Ninos Dr. Arturo Gruillon - in Santiago Dominican Republic - The ICHF has been assisting this unit since January 2006, and currently makes 4 trips/year there. The surgeons on this trip are Drs. Tom Karl and Joanne Starr, who will each do a week. The total trip duration is two weeks, and preference is for volunteers who can do both weeks, although they will look at people who cannot make the full two weeks, in case they are unable to recruit for the full period. Useful, but not essential is any level of Spanish speaking ability, and prior visits to DR or any ICHF site - please specify if any of these apply.
BEIJING-CHINAThe ICHF is in need of another pediat-ric cardiac intensivist for their trip to Beijing Children's Hospital from Oct. 19 - Nov. 1, 2008. The ICHF has been as-sisting Beijing Children's Hospital for 4 years now, and the unit now does over 400 cases a year independently. The surgeon on this trip will be Dr. Novick. The total trip duration is two weeks, and their preference is for volunteers who can do both weeks, although they will look at people who cannot make the full two weeks, in case they are unable to recruit for the full period. You will be one of two intensivists. Useful, but not essential is any level of Chinese speak-ing ability, and prior visits to China or any ICHF site - please specify if any of these apply.
For more information, contact:
Frank Molloy, RN, MScICU Clinical Educator and CoordinatorInternational Children's Heart Foundation1750 Madison #500Memphis, TN 38104 USA+(901) [email protected]://www.babyheart.org
Co-Directors: Giancarlo Biamino, MD; Marc Bosiers, MD; Patrick Peeters, MD; Nina Wunderlich, MD
With lectures, simulator sessions and live case demonstrations ICCA will pro-vide you all you need to start your own carotid stenting program.
ICCA 2008 will provide an update on latest developments in interventional techniques, materials and strategies for treating supra-aortic disease. Compre-hensive lectures given by leading inter-ventional specialists will be combined with live case demonstrations from dif-ferent centers. Attendees will have the opportunity to see different approaches and techniques, step-by-step for begin-ners, as well as difficult cases for expe-rienced interventionalists.
Topics:
• What is the Best Stent for the Carotids?
• How to Select the Best Embolic Protection Device
• Asymptomatic Carotid Stenosis: To Treat or to Wait Until They are Symptomatic?
• Vulnerable Plaque: Does it Tell us who Needs Which Treatment?
• New Trends in Vertebral Stenting
• How to Recanalize the Subclavian Artery
• A new Frontier: Intracranial Stents
• Cerebral Aneurysms
• How to Build an Acute Stroke Program
• How to Manage Complications in the Cath-lab
Who should attend? * Cardiologists * Radiologists * Neurologists * Vascular Surgeons * Neuroradiologists * Angiologists
Headquarters 9008 Copenhaver Dr. Ste. M Potomac, MD 20854 USA
Publishing Management Tony Carlson, Founder & Editor [email protected] Richard Koulbanis, Publisher & Editor-in-Chief [email protected] John W. Moore, MD, MPH, Medical Editor/Editorial Board [email protected]
Editorial Board Teiji Akagi, MD Zohair Al Halees, MD Mazeni Alwi, MD Felix Berger, MD Fadi Bitar, MD Jacek Bialkowski, MD Philipp Bonhoeffer, MD Mario Carminati, MD Anthony C. Chang, MD, MBA John P. Cheatham, MD Bharat Dalvi, MD, MBBS, DM Horacio Faella, MD Yun-Ching Fu, MD Felipe Heusser, MD Ziyad M. Hijazi, MD, MPH Ralf Holzer, MD Marshall Jacobs, MD A.K. Kaza, MD R. Krishna Kumar, MD, DM, MBBS Gerald Ross Marx, MD Tarek S. Momenah, MBBS, DCH Toshio Nakanishi, MD, PhD Carlos A. C. Pedra, MD Daniel Penny, MD James C. Perry, MD P. Syamasundar Rao, MD Shakeel A. Qureshi, MD Andrew Redington, MD Carlos E. Ruiz, MD, PhD Girish S. Shirali, MD Horst Sievert, MD Hideshi Tomita, MD Gil Wernovsky, MD Zhuoming Xu, MD, PhD William C. L. Yip, MD Carlos Zabal, MD FREE Subscription Congenital Cardiology Today is available free to qualified professionals worldwide in pediatric and congenital cardiology. Interna-tional editions available in electronic PDF file only; North American edition available in print. Send an email to [email protected]. Include your name, title, organization, ad-dress, phone and email.
Contacts and Other Information For detailed information on author submis-sion, sponsorships, editorial, production and sales contact, current and back issues, see website or send an email to: [email protected].
October 2008 11 . .
UPCOMING MEDICAL
MEETINGS & SYMPOSIA
Current Topics in Patent Ductus Arteriosus: Strategies for Improved Outcomes. A CME Accredited On-Demand WebcastOnline Webcast available through Feb. 2009www.5starmeded.org/pda-outcomes
The Morphology of Congenital Heart Disease with Imaging and Surgical CorrelationOct. 25, 2008; Boston, MA USAwww.massgeneral.org/children
Management of Congenital Heart DiseaseOct. 25, 2008; Washington, DC USAwww.childrensnational.org
First Phoenix Fetal Cardiology SymposiumOct. 31 - Nov. 1, 2008; Phoenix, AZ USAwww.fetalcardio.com
![Percutaneous Transcatheter Closure of Perimembranous ...for muscular VSD (VSDM) [3], since in the gold standard treatment for the perimembranous VSD is surgical closure with the use](https://static.documents.pub/doc/80x56/6031c4818186ce46207215b8/percutaneous-transcatheter-closure-of-perimembranous-for-muscular-vsd-vsdm.jpg)
